Congratulations Cortney!

We would like to congratulate Cortney Davis, APRN, MA, CFCP on recently becoming certified through the American Academy of FertilityCare Professionals! This distinction is for practitioners that provide exemplary care and education to their clients and submit their charts and files to the Academy for review. Congratulations!

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Feminine Hygeine Products

We women typically learn about feminine hygeine products long before we can drive a car. As Fertility Care Practitioners, we see many women clients who, nevertheless, are not well informed regarding all of the products on the market. So let’s consider some of your questions:

Tampons:
“How often should they be changed?” Ideally, ever 4-6 hours–however it is safe to leave them in up to eight hours.

“Can I put in a super plus tampon for all-day or all-night coverage?” No. Using the lowest possible absorbancy decreases the risk of developing Toxic Shock Syndrome, a very serious blood infection. If you are having a moderate flow day, use a regular absorbany tampon. Tampons should never be left in over night!

“When I insert tampons it feels like tampon is going toward my back; is there something wrong with the placement of my vagina?” No, in fact it’s normal to aim the tampon toward the small of your back for easier insertion. Anatomically, your uterus is situated behind your bladder. Your vagina, the passageway that leads to your uterus is angled up toward the small of your back.

“I always use deodorized (scented) tampons but my practitioner told me not to. Why?” The chemicals used as deodorizers or perfumes in tampons, toilet paper and bath products can cause irritation of the delicate vaginal tissues. In response to this irritation, the vaginal glands produce mucus to “wash away” the irritants. Women who are sensitive to these perfumes and deodorizers may find themselves having abnormal discharges and, in some cases, daily mucus.

Panyliners:
“I wear a pantyliner every day. I like to feel fresh. That’s okay, right?” It’s best to wear all cotton underwear and save the pantyliners for days when you have a heavy flow of cervical mucus or the light days of your period. But if you like to wear a pantyliner every day, be sure to change it several times throughout the day. Also, consider using cloth pads rather than pantyliners to lower the risk of irritation and abnormal vaginal discharge.

Do you have any other questions about feminine products? Please let us know!

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Pregnancy Evaluations & Healthy Pregnancies

FertilityCare Practitioners conduct Pregnancy Evaluations to provide quality control for the Creighton Model System, to provide resources and education to a couple, and to accurately date a woman’s pregnancy. A woman can schedule her pregnancy evaluation as soon as she learns she is pregnant; the evaluation is as accurate in dating a pregnancy as an early ultrasound, which usually is done around 7 weeks. There is no charge for a pregnancy evaluation.

Dating the pregnancy and determining the due date of the baby is fun to do—and couples are happy to know an accurate due date. Most important, having an accurately dated pregnancy is crucial to ensuring that mother and baby receive the best care.

Traditionally, a pregnancy is dated based on the first day of the last menstrual period (LMP). This method of dating assumes that the woman has 28 day cycles and that she ovulated on cycle day 14. With these assumptions, the due date given to the woman is actually 2 weeks LATER than the actual fetal age.

For example, if on October 1st a pregnant woman told her doctor that her last period began on September1st, the doctor would tell her that she was 4 weeks and two days pregnant. This is known as dating the “Gestational Age” of the pregnancy; it assumes the woman conceived exactly fourteen days after her last period began. The actual “Fetal Age,” however, may be very different.

When we look at a woman’s menstrual cycle, there are two phases that are relevant: the pre-ovulatory phase, and the post ovulatory phase. The pre-ovulatory phase is highly variable from month to month and may be short or long; the post ovulatory phase is stable in length. This means that the first day of a woman’s last period has absolutely no bearing on the time of ovulation during her conception cycle. So, how does assuming that all women ovulate on day 14 effect a woman and her unborn baby?

For a first example, let’s assume a woman had a short pre-ovulatory phase in the cycle in which she conceived and that ovulation occured not on day 14 but on day nine. Her baby is actually five days older than the date that would be given to her based on her last menstrual period. Throughout her entire pregnancy, she may be told that her baby is large or that her abdomen is measuring “big” beause the due date given to her is five days later than it should be. Depending on her medical and obstetrical history, she may be encouraged to have labor induced or to have a cesarean section because her baby is “measuring large for its gestational age.”

More concerning is if this same woman should carry past her due date. (Physicians usually allow a woman to carry one to two weeks past her due date at which time labor is induced or a cesarean section is performed. This is done because the placenta which supplies the baby with oxygen and nutrition can fail if a pregnancy carries on too long. Post-term babies are at higher risk for stillbirth, stress during delivery and meconium aspiration. Also, post-term babies tend to be larger, which can pose a difficulty for vaginal delivery.) But in our example, if this woman is allowed to carry to 42 weeks according to her doctor’s dating, the fetal age would actually be 42 weeks PLUS five days. Accurate dating is information that can change and improve the care for a woman and her baby!

Let’s look at a second example: we’ll assume that a woman experienced a long pre-peak phase and ovulated on day 21 of her cycle. At her first pregnancy visit, the doctor will think she is one week farther along than she really is. Her initial blood work—which because of inaccurate dating will be drawn too early—may be concerning because the hormone levels in her blood will be lower than expected. When the first ultrasound is done, her baby will also be measuring “smaller than expected.” This can lead to undue concern of miscarriage or complications.

When this same woman comes close to term she may be offered a repeat cesarean section if she had one previously, but it will be offered to her one week BEFORE her baby is actually full term. If she carries post-dates, her doctor may recommend induction or cesarean, not realizing that her baby is not really post dates at that time but is in fact just at term. Incorrect dating of the pregnancy can have a substantial effect on the prenatal care a woman receives!

Pregnancy evaluations are as accurate as early ultrasounds in determining the actual age of a pregnancy. Since Creighton Pregnancy Evaluations are based on ovulation and conception, not on the LMP, FertilityCare Practitioners are able to provide a couple with the most accurate information regarding their baby’s due date!

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What about The Pill for Endometriosis?

Many doctors advise women with severe menstrual cramps or heavy bleeding to take birth control pills in the hopes that they will suppress any possible endometriosis. These women are generally told that to have the maximum therapeutic effect they should take the birth control pill as long as possible. To understand why many doctors recommend The Pill, it is necessary to first understand endometriosis.

Endometriosis is a condition in which cells which normally line the uterus are also found outside of the uterus. These endometrial implants can be found on the bladder, the intestines, in and on the fallopian tubes and on the ovaries. When a woman has normal cycles, the developing follicle (egg) on the ovary secretes estrogen; the estrogen acts on the lining of the uterus, signaling it to proliferate, becoming thicker and more vascular so that it can potentially support a baby. In a woman with endometriosis, the estrogen tells the lining of the uterus to build up, but it will also stimulate the endometrial implants outside the uterus to grow and proliferate. The theory behind prescribing hormonal contraception is that if the woman does not ovulate then the endometrial implants will not be stimulated, therefore the endometriosis won’t progress further.

There are many things to consider regarding the treatment of endometriosis with The Pill. First, there are the numerous side effects and contraindications of hormonal contraceptives. Side effects may include nausea, weight gain, sore breasts, blood clots, spotting, and decreased libido. The traditional birth control pill is not recommended for women over age 35, smokers, or those who are nursing. Also, although the birth control pill is supposed to suppress ovulation, it does not always do so. The Pill’s other actions include thickening the cervical mucus in order to impede sperm transport, and thinning the lining of the uterus, making unable to support a developing baby. In addition, there is a risk of breast cancer and infertility down the road for women taking birth control pills.

The only way to actually diagnose endometriosis is with a surgical procedure that allows the doctor to see and eliminate the endometial implants in the abdominal cavity. Many women are being treated with the birth control pill for presumed endometriosis, meaning they have heavy bleeding and cramping but have never been diagnosed. These women may end up taking medication for all of their reproductive years without a real diagnosis, or real treatment.

In the Creighton Model System, women with symptoms of endometriosis are sent for a consult with a NaPro Technology trained surgeon. Surgical treatment with a NaPro trained surgeon results in a very low incidence of adhesions or recurrence of implants, two of the primary concerns of endometriosis surgery. Because endometriosis can be a factor in infertility, surgical intervention is the only treatment that results in the greatest improvement in symptoms and the best chance of achieving a pregnancy in the future.

In the Creighton Model System, the cause of a woman’s symptoms such as heavy bleeding, pelvic pain, or infertility must first be diagnosed—and the cause may or may not be endometriosis. Hormone imbalances or other conditions such as fibroids can also cause heavy bleeding. The woman is treated based NOT ONLY on her symptoms but also on the actual disease process, resulting in real curative treatment as opposed to a mere suppression or temporary limitation of symptoms which is the effect attained with hormonal contraception.

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Practitioners of Nutmeg FertilityCare Participating in Panel Discussion

Come to St. Mary’s Church in Norwalk, tomorrow, Saturday July 9th. The Gospel of Life Society is featuring a panel discussion of FertilityCare Practitioners including all of the practitioners from Nutmeg FertilityCare! Topics will include NaPro Technology, pre-menopause, infertility, and family planning. The Mass begins in the church at 9am, the meeting follows in the church hall at 10am.

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Quarterly Meeting

The practitioners of Nutmeg FertilityCare meet quarterly to discuss the center, review policies and research that pertains to our work as well as case studies. The picture shows the post-meeting recreation in Litchfield, Connecticut.

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Timeline for Treatment

When a woman has a chronic complaint, like PMS or infertility, two cycles (or two months) of charting are typically necessary for referral to a NaPro Technology trained physician. Then there is usually one cycle of diagnostic testing which is done at various points in a woman’s cycle based on the signs of fertility and infertility that she is charting. After this diagnostic cycle, a woman can expect to meet with her NaPro physician again and begin treatment. Couples with infertility can therefore expect to complete three or four cycles of charting before treatment begins.  (A woman or couple with medical issues requiring urgent attention will be referred to a NaPro physician immediately.)

NaPro Technology is designed to discover and treat the cause of chronic gynecological or obstetrical problems rather than simply covering up or bypassing the underlying cause.  For more information visit www.naprotechnology.com.

 

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